Healthcare Provider Details

I. General information

NPI: 1568877553
Provider Name (Legal Business Name): RYAN ANTHONY GERARD KUNJAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

660 SOUTH EUCLID AVENUE
SAINT LOUIS MO
63110-1343
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-7211
  • Fax:
Mailing address:
  • Phone: 904-207-0508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: